Fresh review of maternity services ‘could risk stability’

An independent review of redesigned maternity services in East Sussex could put their stability at risk, a health boss has suggested.

The maternity unit at Eastbourne’s District General Hospital was downgraded in 2013, a decision later made permanent, with a consultant-led unit retained at Hastings’ Conquest Hospital.

A review of the issue, conducted by Eastbourne Borough Council with the Office for National Statistics, was published late last year including 1,700 survey responses from women who gave birth in East Sussex in 2016.

It found that 93 per cent of mothers from the Eastbourne, Hailsham and Seaford areas would choose to give birth at the DGH if a full obstetric service was available.

Its publication has led to fresh calls for an independent review into the redesign of the county’s maternity services, but these were opposed by health bosses at an East Sussex Health Overview and Scrutiny Committee (HOSC) meeting last Thursday (March 29).

Amanda Philpott, chief officer for both the Eastbourne, Hailsham and Seaford and Hastings & Rother clinical commissioning groups, suggested the prospect of an independent review could put at risk the confidence in, quality and stability of maternity services.

She explained: “All of the indicators are in the expected range and towards the better end for the most part.

“It would be unusual to call for an independent review and we would share the concern from a commissioning perspective that in a time of great pressure on services and the way in which we use our resources, it would unsettle a workforce that is doing its very best to stabilise the service.”

Campaigners who have supported the return of a full maternity unit to the DGH have highlighted the long travel time for women in labour being transferred from Eastbourne to Hastings.

Robert Smart, an Eastbourne borough councillor who introduced the survey to HOSC members, focused on the eight stillbirths for women living in Eastbourne in 2016 compared to 11 across the rest of the county.

He also criticised the way the NHS had presented its data to the committee.

He said: “It may be a small number but it is a critical number and it’s just not good enough for the CCGs to create rose-tinted statistics rather than engage with our statistics that we derived directly from the ONS.”

He highlighted a piece of work from the Netherlands which suggests transfer times of at least 20 minutes increases risk.

He said: “There appears to be almost a conspiracy among the NHS establishment in the UK to ignore this key parameter.”

Mr Smart went on to suggest the return of a consultant-led midwife unit in Eastbourne would ‘pay for itself’ due to a resulting reduction in settlements in cases of negligence.

He asked if the East Sussex Healthcare Trust, which runs both DGH and Conquest, was ‘marking its own homework’ in terms of the statistics it had presented.

Of the eight stillbirths from Eastbourne in 2016 all happened before labour.

According to the ESHT report to the committee: “Each event has been individually reviewed and there is no evidence that the availability of an obstetric labour ward in Eastbourne was a contributory factor.”

Ms Philpott described some of the comments as ‘unfortunate’, adding: “It’s not a subjective self assessment to determine whether or not we are good enough, it’s driven by a desire for our services to be the best or as good as we can do but it’s also independently checked.”

Jessica Britton, chief operating officer for the two CCGs, described how the difference between NHS figures and the ONS data was down to how health organisations had to report their data nationally.

She said: “Rather than being rose-tinted this is how it is and we will be happy to have a conversation about the figures or information that this represents.”

Ruth O’Keeffe, vice-chair of HOSC, said that while these were tragedies for those involved there were some stillbirths that ‘nobody could have done anything about’.

He also raised the high numbers of ‘babies born before arrival’ (BBA) and asked if this was a problem with the prenatal service.

The NHS trust recorded 85 BBA events from January 2016 to December 2017,

A total of 62 were received at Conquest, with 21 women coming from Eastbourne and 41 from Hastings, compared to 20 at the DGH.

Sarah Blanchard-Stow, head of midwifery at ESHT, explained that it was categorised as a BBA if a birth happened before the arrival of a midwife so could still occur in a hospital.

She outlined how all of these BBAs had seen babies born in safe conditions, but each was reviewed to make sure mothers had been given clear and relevant advice beforehand.

She said: “As much as we can try and prepare for these events some women will labour extremely quickly and with the best will in the world we can’t always get to a lady who has had a precipitous labour.”

According to ESHT there have been no serious incidents as a result of transfers from the DGH to Conquest.

County councillor Angharad Davies suggested the Netherlands study could not be relied on as a scientific piece of work and called the Eastbourne survey ‘flawed’ because it had asked ‘such pointed questions’.

But Janet Coles, an Eastbourne borough councillor, said: “The best way to deal with this is to have what you said you would like is a rigorous independent review by a body with appropriate expertise and integrity so that with all the information at hand we can say that the reconfiguration has worked or it has not worked and that way we will know for sure.”

Mary Barnes, a Rother district councillor, defended the NHS report, saying: “It does definitely seem to me there’s been all-round improvement in maternity services since the reconfiguation.”

Vikki Carruth, director of nursing at ESHT, added: “All of the decisions that we have made and continue to make first and foremost are about making sure the safety of mothers and babies is paramount.

“We appreciate that will not always necessarily be what local mothers want of course as they may well want services that are closer to home.”